Andrea Otterness, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

302520 Issued in MN

Practice address

555 W Broadway Ave Ste 1And2
Forest Lake, MN 55025-1175

Phone

(651) 777-5222

Fax

(651) 251-5279

NPI assigned

Nov 5, 2015

Last updated

Nov 5, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Canvas Health, Inc.

  • Mental Health Counselor
  • Oakdale, MN
  • NPI 1922051325
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446681600000",
    "number": "1831562305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 WEST BROADWAY AVE SUITE 2",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "55025",
            "telephone_number": "651-777-5222",
            "fax_number": "651-251-5279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W BROADWAY AVE STE 1AND2",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550251175",
            "telephone_number": "651-777-5222",
            "fax_number": "651-251-5279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTERNESS",
        "first_name": "ANDREA",
        "name_prefix": "Ms.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-05",
        "last_updated": "2015-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Weston Mark Obrycki, DPT
• Oluwakemi Tinuke Olowoyo, M.D
• Janet Darlene Olson, PT, OTR
• Laura Marie Olson, BS
• Colleen Lynn Orde
• Leann Rose Ottomeyer, DNP, APRN, FNP-C
• Richard Vincent Ottomeyer, D.C.
• Lyn Marie Palacheck, CNS
• Ethan Kai Palmer
• Randy Parent

• Addiction (Substance Use Disorder) Counselor in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.